Everybody’s Talking About Information Blocking

How do we achieve data liquidity now without waiting for mandates and EHR vendors to conform?

Mark Dunnagan

Mark Dunnagan Follow

May 1, 2019

Brick wall representing information blocking

Thanks to the Office of the National Coordinator (ONC), everybody’s talking about information blocking these days. The topic is a heated one and organizations like the American Medical Association (AMA) and Electronic Health Record Association (EHRA) are saying, “Hold up. This is huge. We need more time to review your proposed rule”. Through a letter to the Office of the National Coordinator for Health Information Technology (ONC) and The Centers for Medicare and Medicaid (CMS), EHR vendors have flat out said they fear that a rush to implement new standards and measures will have “unintended consequences and added provider burden.” People and companies across provider groups, payers, healthIT companies, and more are on high alert. There’s much to gain and potentially lose. It’s risky and complicated.  

Information blocking is the intentional interference in the exchange and use of health information – addressing it is a great step forward and a much-needed conversation in our industry. We absolutely have to hit the lack of EHR data access head on, especially when it’s a result of blatant data hoarding. With healthcare spending at its highest ever, we have no choice but to ensure we’re all on the same ‘health data sharing’ team regardless of whether we’re competitors.

So, what interoperability approach will get us to the place where information is readily available at the point of care? The ONC is strongly pushing FHIR APIs as the solution. But what do we do now to ensure timely access to and the exchange and use of health information? How long will it take for the industry to coalesce and for data to flow?

Will FHIR APIs Blast Through Information Barriers?

Years ago, interoperability meant the ability to send a Continuity of Care Record (CCR) to another clinician. Later, if you could generate and send a Continuity of Care Document (CCD) via a direct secure messaging (DSM) system, you were in great shape.  Now, your EHR needs to be able to produce a Consolidated Clinical Document Architecture (CCDA) document and support Integrating the Health Enterprise (IHE) profiles, or you are behind the times.

With the proposed use of FHIR-based APIs, the ONC envisions the EHR as the gateway to a world of service partners that drive more opportunities to sell software and make their clients (and their clients’ clients) happy. The economical advantage is tied to the open flow of data and to vendors that design their systems and integrations with this in mind.

Even though the API interoperability path has worked well in other industries for companies like Salesforce, there are a few significant challenges in reaching FHIR API nirvana in healthcare. First of all, the EHR vendors said publicly in 2017 that they’re not going to implement all parts of FHIR because many have invested in developing their own API frameworks. And even if there is an actual legislative mandate that evolves from the ONC’s proposed rule, it’s going to take years to implement. Secondly, as patient data becomes more fluid via APIs, there’s a whole set of cyber security standards that will need to be agreed upon and deployed. And last but not least, and perhaps the biggest hurdle is getting to the data that Meaningful Use has unfortunately left behind like behavioral health, dental, and other data that doesn’t fit into a common set of use cases supported by a standards-based construct.

How Can We Achieve Data Liquidity Now Without Waiting for Legislative Mandates and EHR Vendors to Conform?

As much of an isolated conundrum as this seems, healthcare is not alone when it comes to these interoperability challenges. There are lessons to be learned from aeronautics, automotive, and consumer electronics industries that are available today to move organizations beyond information blocking and interoperability, directly into data liquidity. Perhaps the biggest ‘a-ha’ these industries discovered was front end integration – the power of leveraging the user interface versus the database to get to data. If we were to compare EHR data extraction and insertion to going in and out of a house – we’d realize that using the front door instead of digging a hole, adding a pipe underground, and coming up through the basement is a heck of a lot cheaper and faster.

The thing to remember: If you’re looking for a way to bidirectionally exchange data with disparate EHRs or other core operational systems like practice management, billing, radiology, lab, and others, there are new and innovative alternatives to HL7 and other back end database approaches. You can get to the same data and more with front end integration, an approach other industries have used for decades to securely integrate thousands of complex systems, improve quality ratings, and save billions.

Interested in learning more about front end integration? Smartlink’s CEO, Siu Tong, PhD, an aerospace engineer, was a key player in developing the approach that has become the standard for most of the largest companies in the world today. He did this over 25 years ago and recently refreshed and rearchitected his work to address the unique needs of healthcare.  Smartlink Data Connector (SDC) launched in February 2018 and has already gained strong traction with accountable care organizations, clinically integrated networks, health information exchanges, and independent labs.

Get in touch today to learn how SDC can empower your data sharing initiatives in lieu of HL7, IHE/Interoperability, FHIR, etc., providing speed to data at a fraction of the cost and time of traditional implementations.

Mark Dunnagan

As the VP of Health Informatics, Mark is an experienced and pragmatic technology executive focused on the delivery of services and the continual improvement of Smartlink Health's connection methodologies. He also loves 'farm living' with his wife, kids, dogs, and horses.